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Updated: Aug 13, 2026
Murine Cervical Heart Transplantation Model Using a Modified Cuff Technique
Published on: October 12, 2014
Cardiac allograft vasculopathy in pediatric heart transplant recipients
Eba Hathout1, W Lawrence Beeson, Micheal Kuhn
1Department of Pediatrics, Loma Linda University School of Medicine, CA, USA.
Insights
Frequent and severe rejection episodes may predict pediatric coronary allograft vasculopathy (CAV) after heart transplantation. Metabolic factors like cholesterol, LDL, diabetes, and hypertension did not significantly impact CAV development in this cohort.
Area of Science:
- Pediatric Cardiology
- Transplant Immunology
- Cardiovascular Research
Background:
- Coronary allograft vasculopathy (CAV) is a significant long-term complication following pediatric heart transplantation.
- Metabolic parameters associated with CAV risk are not well-established in this vulnerable population.
Purpose of the Study:
- To investigate the relationship between metabolic parameters and the development of CAV in pediatric heart transplant recipients.
- To identify predictors of CAV in children managed with a cyclosporine-based, steroid-sparing immunosuppression protocol.
Main Methods:
- Retrospective analysis of 337 pediatric heart transplant recipients.
- Data collection included CAV diagnosis (angiography/autopsy), rejection episodes, hemodynamic compromise, HLA DR mismatch, pacemaker use, homocysteine, cholesterol, LDL, diabetes, and hypertension.
- Multivariate logistic regression analysis was employed to identify significant predictors of CAV.
Main Results:
- Freedom from CAV was 79% at 10 years post-transplant.
- 18% of patients developed CAV at a mean of 6.5 years.
- Higher rates of first-year rejections (P=0.003) and rejection with hemodynamic compromise beyond one year (P<0.001) were significantly associated with CAV development.
- No significant correlation was found with HLA DR mismatch, pacemaker use, homocysteine, cholesterol, or LDL levels.
- Diabetes and hypertension were not significant predictors of CAV on multivariate analysis.
Conclusions:
- Frequent and severe rejection episodes are significant predictors of pediatric CAV.
- Metabolic abnormalities, including glucose intolerance and lipid profiles, did not appear to alter CAV risk in this pediatric heart transplant population.
- These findings highlight the critical role of managing immunosuppression to prevent rejection episodes in mitigating CAV risk.
Abstract:
Metabolic parameters for coronary allograft vasculopathy (CAV) have not been well defined in children. CAV (by angiography or autopsy) was studied in 337 heart recipients on a cyclosporine-based steroid-sparing regimen. Freedom from CAV for all was 79% at 10 years. Fifty-nine patients (18%) developed CAV at a mean of 6.5 +/- 3 years post-transplant. First year rejections were significantly higher in CAV, mean 2.3 vs. 1.4, P = 0.003, odds ratio (OR) 1.8. Rejection with hemodynamic compromise beyond 1 year post-transplant was associated with CAV, P < 0.001, OR 8.4. There was no significant correlation among human leukocyte antigen DR (HLA DR) mismatch, pacemaker use or homocysteine levels and the development of CAV. Maximum cholesterol and low density lipoprotein (LDL) levels were not significantly different. Neither diabetes nor hypertension was significant predictors of CAV on multivariate logistic regression analysis. In conclusion, frequent and severe rejection episodes may predict pediatric CAV. Neither glucose intolerance nor lipid abnormalities appeared to alter risk for CAV in this population.
